Harris County, TX

Higher blood lead levels (BLLs) in children are more likely to occur in areas that are generally below the federal poverty level. The Texas Department of State Health Services (TX DSHS) reported that in 2019, 646 children under the age of six years who received blood lead tests in Harris County had BLLs of 5 µg/dL and above that required follow-up actions. While exposure to lead is still a threat, many families are unaware and are not being encouraged by healthcare professionals to test their children for lead.

In 2017, the Lead Testing Program was piloted in two Harris County Public Health (HCPH) Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) clinics located within the Greater Inwood of North Houston and Pasadena communities. The purpose of the pilot program was to increase testing rates amongst these populations who are underserved by raising lead awareness through educational campaigns, outreach and education, and offering lead testing. The pilot proved to be a success as the number of children who were tested for lead through WIC increased by 18% from October 2017 through September 2018. In March of 2020, the number of children who received lead testing at the WIC clinics decreased because of the pandemic. To continue the collaboration with WIC, the program staff developed a plan to revamp the lead testing program by increasing the number of WIC clinics that offer lead testing. The program currently partners with four HCPH WIC clinics to increase testing and raise awareness of the dangers of lead and how to prevent exposure. Expanding lead testing services to additional WIC sites will give the program a better scope of how many children are exposed to lead.

Lead testing was successfully implemented in two additional WIC clinics thanks to the program’s redesign. Since the Lead Testing Program was modified and reintroduced in November 2022, a lead test has been administered to approximately 1,441 children under the age of six years at the four WIC sites. The established partnership with WIC will continue to improve the number of children who are lead-tested and raise awareness among their parents and households. Additionally, families enrolled in WIC will have the opportunity to obtain their first lead test as well as connections to care for children who are discovered to have blood lead levels of 3.5μg/dL and higher.

Harris County is home to many industries that produce airborne lead contaminants. Harris County is also home to Guatemalan, Honduran, Salvadoran, and Mexican communities that use traditional ceramic pottery that may be glazed with lead. While the incidence of lead poisoning has gradually declined in the U.S., disparities continue to exist among this economically disadvantaged population in Harris County. Children under 72 months of age are at a higher risk for long-term damage caused by lead poisoning. In 2017, approximately 1.95% (6,767) of children ages ≤ 5 years old in Harris County were considered to have elevated blood lead levels (BLLs). Children eligible for Medicaid are at a higher risk for elevated BLLs. However, blood lead testing is not conducted as a part of routine visits at Women, Infant, and Children (WIC) clinics in Harris County where many of these children are Medicaid-eligible.

Due to lack of resources, no targeted childhood lead testing or lead poisoning prevention education had been provided to the underserved populations in the Greater Inwood of North Houston and Pasadena communities. The Harris County Childhood Lead Poisoning Prevention Program (CLPPP) partnered with two Special Supplemental Nutrition Program WIC clinics in Harris County. These clinics were selected because 75% of the children enrolled in WIC are eligible for Medicaid and are at higher risk for elevated blood lead levels. Additionally, these communities are home to Latin American families that may use lead-based ceramic pots and pans, live in housing located near industries that produce airborne lead contaminants, and live in homes built before 1978. In these communities, the Harris County CLPPP provided lead poisoning awareness education and increased blood lead testing for children. WIC providers received linguistic and culturally appropriate lead education and informational materials to effectively increase lead awareness amongst their patients. After receiving lead poisoning and prevention education, patients at these WIC clinics were also offered additional resources and services.

Prior to partnering with WIC, 1,803 children in the selected communities were screened for lead exposure. After Harris County CLPPP initiated their educational intervention at the WIC clinics in the Greater Inwood and Pasadena communities, 2,119 children were screened from October 2017 through September 2018. This represents an 18% increase in children served compared to before Harris County CLPPP partnered with WIC. The program plans to extend this intervention to ten additional WIC clinics within its jurisdiction.